Provider Demographics
NPI:1265031892
Name:CLIFFORD, CHRISTINA RENEE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:RENEE
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 6TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2015
Mailing Address - Country:US
Mailing Address - Phone:518-928-0531
Mailing Address - Fax:
Practice Address - Street 1:2421 6TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-2015
Practice Address - Country:US
Practice Address - Phone:518-928-0531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339648-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse